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General NPI Number Information
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NPI Number | 1528763265
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Entity Type | Organization
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Legal Business Name | PEACH TREE COUNSELING, LLC
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Dates
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Enumeration Date | 04/03/2023
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Last Update Date | 04/03/2023
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Provider Practice Location Address
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Address Line | 1206 W SOUTH JORDAN PKWY STE C
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City | SOUTH JORDAN
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State | UT
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Zip | 84095-5511
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Country | US
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Telephone | 385-253-8002
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Fax | 385-275-0017
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Provider Business Mailing Address
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Address Line | 1206 W SOUTH JORDAN PKWY STE C
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City | SOUTH JORDAN
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State | UT
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Zip | 84095-5511
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Country | US
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Telephone | 385-253-8002
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Fax | 385-275-0017
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Authorized Official
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Title or Position | LCSW/OWNER
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Name | STEPHANIE HEINHOLD
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Credential | LCSW
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Telephone | 678-478-4217
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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